CPP and other over payments on your long term claim


#1

In the master policy ( not likely in your policy booklet from work) is a section that outlines how over payments such as CPP and other lump sum amounts you may receive and be required to reimburse the Insurer is to be paid back.
In my husbands policy he has 6 months to pay back any over payments made on his claim. There was also a recent court decision that allowed a claimant to have the lump sum pro-rated over the policy until he turned 65-pointing out that an Insured may prefer this. That insured had under the over payment provision in his policy the right to opt for that. This maybe another good reason to not sign the irrevocable consent to deduct and pay an Insurer directly form.

No doubt your Insurer will coerce you to pay back your overpayment in full immediately. Do Not Listen To Them -Read Your Master Policy! Although you are required to pay back the benefits, doing so in full places you at risk of having your benefits denied and the insurer keeping your money. At this point, you must subscribe to the Second Golden Rule: “He who has the gold makes the rules.” You will instruct the insurer to take the overpayment from your future benefits. Better for you to budget yourself from funds in savings than to hope for payment each month from a greedy insurer who can deny your claim at will with little recourse to it.

This is just a thought-for many it may not be worth the aggravation.


#2

Thank you for clarifying. I’d like to try this in case if I am approved for cpp-d.

In addition, the policy says that the total income should not exceed 85%. There was a case in court when an insured tried to keep both ltd and cpp-d payments as they didn’t exceed 85% but it was denied by the judge. Doesn’t seem right to me.

Not sure if we have much on them :slight_smile:


#3

I know that case too! My husbands LTD is non taxable and 66% of his take home pay. But he only gets 51% of pay because his max benefit is 1980.00 a month. We plan to try and go for the net CPP-D after tax deduction or have it subtracted from the 66% of his income amount. He has the 85% all source too-but I know that would fail.
He just got his estimated CPP-D so we are going ahead with suing GWL, an employee (the rehab consultant), the psychologist and physiotherapist they sent him too.
We have not heard from CPP but did get his updated claim file and GWL sent all his medical too-so there is hundreds of pages for CPP to get through.


#4

Since GWL breached the contract we are going to try and argue that they can not rely on the contract to set-off the CPP-D amount.


#5

Is there need to sue that much? What about credibility?


#6

They have already admitted negligence-it is very outrageous what was done. We have a legal opinion and paying to have the claim done by a lawyer. We are only suing under our simplified rules-more on principal and accountability.
Many people are exploited and lied about during rehab-and there are privacy issues we want to challenge under our Privacy Act. GWL entered into a secret contract with “his treatment” providers ( there chosen referals) to demand that GWL must get any reports prior to the Insured. Two parties can not agree to violate another’s rights. They all forgot about consent forms and then tried to cover it up by saying he refused to sign.
So much more. To be forced into psychological testing and medical testing really harmed him. Then the cover up. Then the apology for the mishandling.
The physiotherapist also was having a letter sent to his doctor to say he would not sign a form (non-cooperation) that he had not been asked to sign.
It goes on-the cover up will bust them.
They also lied to us by saying his Doctor was aware of their plan-which was also a lie. He was also not off on any psychological claim at the time so the testing was unauthorized and unnecessary
The psychologist promised us if he did the testing he would give us a copy of the report-then next appointment changed his mind. The psych also guaranteed that before he discussed anything with the Insurer he would call and get the OK. from us.
That too was a lie.
Not at all worried about credibility


#7

Also by filing a claim it becomes a public record. My husband would like to approach the news programs about Insurer’s using psychologist/psychiatrists as part of their claim handling.
You would be surprised how many claimants are sent to psychologists and under pressure to answer deeply personal questions and harmed by that process. Even those who are not off on any psychological claim.
Often this is a very shady area of what Insurers do and Insureds are subjected to unfair treatment that violates professional codes and are against the law


#8

That doesn’t sound good. Dealing with insurance can be quite frustrating. Hope everything will work out well.


#9

I would advise extreme caution here. If the overpayment is large enough insurers will issue a lawsuit against for collection. If a judge believe the insured person acted in bad faith regarding the terms of the contract, then that could result in a harsher decision against you. Both the insured person and the insurance company have duties of good faith.


#10

I agree to use with caution. If the contract has a provision that sets out a time frame for when an over payment is required to be reimbursed it might be worth a try to ask and quote the provision.


#11

I think I read (David can correct me) that legal fees (if you have to appeal) can be negotiated between the lawyer and insurance company so that they can be paid out of the back payment lump sum.


#12

That is true-David can approach the Insurer, even if you have signed the irrevocable forms, to see if it can be negotiated that his fees are deducted from the over payment with the rest going to the Insurer.
If you have to appeal this is a excellent option to pursue. As Resolute Legal is national-anyone who has to appeal can approach this.


#13

When we sue the insurance company the legal fees are paid out of the lump sum payment of benefits we get from the insurance company. However, once we sue them, they also have to make a payment of “costs” which will offset the legal fees you pay. As lest with our law firm, you get 100% of the costs payment so it offsets the legal fees you are paying out of your lump sum benefit payment.


David Brannen

Disability Lawyer with Resolute Legal

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